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National Assembly: Drugs, Alcohol Abuse,
and the Criminal Offender
Tuesday, December 7, 1999

The Systems Approach:
A Discussion of Implementation and Obstacles

Moderator:
Michael Link, Assistant Chief
Ohio Department of Alcohol and Drug Addiction Services
Columbus, Ohio

Panelists:
Panel A:
Jennifer Mankey, Project Director
Denver Juvenile Network
Denver, Colorado
Panel B:
Roger Peters
Lead Consultant, GAINS Project
Assistant Professor, University of South Florida
Tampa, Florida

John Robinson, Undersheriff
Cook County Sheriff's Department
Chicago, Illinois

Mark Fontaine, Executive Director
Florida Juvenile Justice Association
Tallahassee, Florida

Michael Sarbanes, Executive Director
Maryland Governor's Office of
Crime Control and Prevention
Baltimore, Maryland

Carol Shapiro, Project Director
Bodega de la Familia
Neighborhood Drug Crisis Center
New York, New York

Michael Couty, Director
Missouri Division of Alcohol and Drug Abuse
Jefferson City, Missouri

Thomas Conklin
Director of Health Services
Hampden County, Massachusetts
Correctional Center

Summary of Proceedings

Panel A

Panelists argued for a multidisciplinary, systems approach to dealing with problems of substance abuse and criminal activity, regarding them as interrelated problems instead of separate, isolated behaviors. Cross-agency programs increase program effectiveness, generate significant financial savings, and increase public safety. Discussion centered on why a systems approach is needed in dealing with these problems and how to implement cross-agency efforts.

"At the neighborhood level, there is no treatment problem independent of a criminal justice problem independent of a prevention problem," said Michael Sarbanes, Executive Director of the Maryland Governor's Office of Crime Control and Prevention. If the work does not translate to the street, there is no long-term impact.

For maximum effectiveness, "you have to work with the community," identifying all relevant community-based resources, including religious and other local social organizations, to help solve the problems, said Michael Couty of the Missouri Division of Alcohol and Drug Abuse. These problems are related, and the bottom line is that clients need to be able to live securely from day to day before rehabilitation can begin. "If we do not attend to basic needs—employment, housing, etc.—[our attempts] are not going to work," said Couty.

Although such efforts often are difficult to implement because each organization brings different ideas and priorities to the table, he noted, the end result is more effective than if each organization tried dealing with the problems on its own. In many cases, one organization comes to the partnership with more money and resources than another. However, the poorer partner may bring some expertise that the better-endowed agency lacks. A third partner may bring services, expertise, facilities, or other resources not directly available to the others. For maximum effectiveness, all partners need education about one another's needs and resources, said Couty.

Since substance abuse and crime affect both families and communities, local public institutions such as schools are natural "points of intervention" to stop drug abuse and crime, said Jennifer Mankey, Executive Director of the Denver Juvenile Network. More inclusive collaborations can help agencies focus on what issues families face, instead of what services individual agencies can offer. "It all points to collaboration," said Mankey.

In Cook County, Illinois, combining corrections with treatment helped the county make the most of its limited resources, said Undersheriff John Robinson. After a study found that 30 percent of inmates could be supervised outside jail, the county set up a continuum of comprehensive supervision options. In addition to providing effective treatment and supervision for those offenders outside the jails, use of these options lessened crowding in the county's facilities. Money that might have been used to expand jail capacity was saved.

In response, Wall Street investment firms upgraded the county's bond rating, saving the county $100 million in debt service each year. Cook County now offers a range of treatment programs including early intervention, prevention, and diversion from the criminal justice system. "Our facility treats 100,000 people a year. If we are successful 1 percent of the time in having a person not return to the facility, we would save $4.6 million a year," said Robinson.

Panel B

Discussion on the second panel focused on barriers and challenges to implementing a systems approach. Panelists argued that communities must take into account the special needs of specific populations, such as juveniles and persons with physical or mental illnesses, as well as the need to develop common goals and resolve complicated logistics issues using previously untapped resources.

Large proportions of offenders in prisons and jails are mentally ill in addition to having substance abuse problems, noted Thomas Conklin, Director of Health Services, Hampden County, Massachusetts Correctional Center. More clients with mental illness reside in jails and prisons than in all the hospitals and mental institutions in the country, he said. The Los Angeles County corrections system alone houses between 1,500 and 1,700 mentally ill inmates each day, more than any psychiatric hospital in the country.

Fewer than 10 percent of jails and prisons have any discharge planning services for inmates with mental illness. "Many discharge plans consist of $1.50 and a bus token. We must do better than that," said Conklin. Similarly, Mark Fontaine of the Florida Juvenile Justice Association noted that society has moved mentally ill people from one type of institution, mental health facilities, to another, prisons.

These offenders need a wide range of services provided by several different agencies, and they do not respond well to traditional substance abuse programs, noted Roger Peters of the University of South Florida. They should be in specialized programs with trained staff who can provide different treatment formats and understand the use of medications and their side effects. In addition, the Federal Bureau of Prisons is collaborating with several states to develop programs that ease the prison-to-community transition for mentally ill offenders. Successful programs require intensive support in the immediate post-prison period. In Texas, for example, mental health workers go to the prison door and take newly released inmates to their first mental health appointments.

Juveniles also have an overwhelming need for specialized services and collaborative treatment, said Fontaine. In a recent Florida survey of juveniles in custody, half had mental illnesses, a third had substance abuse problems, and many others were at risk of developing these and other problems. At present, Florida law enforcement and the relevant departments—juvenile justice and children and families—are all seeing the same young people, who bounce from one agency to another. Instead, resources from all agencies must be integrated.

Prisoners also have serious medical concerns that need addressing, Conklin added. In the last year alone, 17 percent of all AIDS victims, 30 percent of those with hepatitis C, 15 percent of hepatitis B carriers, and 35 percent of all Americans with tuberculosis went through state or local corrections systems. However, current federal legislation bars prisoners from receiving either federal or private insurance payment for medical care while incarcerated. As the rate of untreated disease increases, this policy will most likely be costly to the federal government. For every case of hepatitis B that is prevented, the United States saves $96,000. "We cannot have a community standard of care and a corrections standard of care," he said.

In the course of collaboration, agencies unintentionally can send conflicting signals about their priorities, which can undermine their goals. For example, sending a convict to drug treatment instead of prison can make treatment look like a second-choice punishment, designed to save space in the local jail. Instead, agencies need to make it clear that drug treatment is a meaningful intervention, good for the individual and good for the community.

Typically, services for juveniles are even more compartmentalized. The criminal justice system focuses on crime, substance abuse personnel deal with treatment, and child welfare officials deal with child welfare. However, "the child is the common factor in reality," Fontaine said.

To deal with the complicated logistics of coordinating different medical, mental health, and substance abuse treatment needs, Peters noted, Florida is working on a new neighborhood integrated health center model, where service providers from various disciplines will be located in a single place for "one-stop shopping." By working together in a single health center, service providers can make it easier for released prisoners and other clients to get all the services they need. In addition, this approach will facilitate cross-agency communication regarding client needs and services.

Carol Shapiro of the Bodega de la Familia Neighborhood Drug Crisis Center noted that, in carrying out their work, agencies often ignore critical untapped resources including one of the most powerful, the family. Working with the family as a unit provides the opportunity to offer integrated prevention and treatment services, treating several generations at once. Effective family case management also can reveal problems a single agency might miss, such as when a juvenile might be released from custody into a home where an adult is on parole or where domestic violence threatens the stability of the home.

"We have 10 million people a year moving in and out of the criminal justice system. How do they go back to their communities? Angry, unchanged, and deprived," said Conklin. Effective treatment during incarceration can give inmates a chance to rethink their lives and make more effective choices.


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